- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... range of medical/clinical knowledge. + Expertise in, or willing to learn utilization management , state/federal regulations, private payer contracts. + Dedication… more
- Centene Corporation (Jefferson City, MO)
- …front-line medical directors including but not limited to scheduling needed Utilization Management coverage, annual goal development, monthly 1:1s, ... Medical Officer in the execution of strategic clinical initiatives + Participate in utilization review studies, evaluate adverse trends; and collaborate with CMO… more
- Centene Corporation (Carson City, NV)
- …preferred** + **Time Zone Alignment: Team is based in Pacific Time** + ** Utilization Review experience within a managed care organization** + **Coordinate with ... care + Interacts with providers, community agencies, and other utilization review staff to coordinate and ensure...discharge plans taken on member medical records in health management systems according to utilization management… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... + A minimum of three years of experience in utilization management , preferred + Team leading or...+ Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of… more
- Northwell Health (New Hyde Park, NY)
- …for the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug therapy ... plans + Experience in formulary management , P&T committee support, and/or utilization management (PA, ST, QL) criteria development + Experience with benefit… more
- University of Southern California (Arcadia, CA)
- …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... follows up to resolve problems with payers as needed. + Completes utilization management for assigned patients. + Coordinates/facilitates patient cares… more
- Evolent (Columbia, SC)
- …As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Helena, MT)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Penn Medicine (Eatontown, NJ)
- …of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM ... treatment, treatment plan development and coordination, referent relations, discharge planning, utilization management with insurance companies, and case … more
- Penn Medicine (Hamilton, NJ)
- …of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM ... treatment, treatment plan development and coordination, referent relations, discharge planning, utilization management with insurance companies, and case … more